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Kim H, Kim S, Ahn MY, Oh DH, Choi JP, Yang E. Case Report: Cryptococcal Meningitis in a Previously Immunocompetent Patient with Coronavirus Disease 2019. Am J Trop Med Hyg 2024; 110:270-273. [PMID: 38190753 PMCID: PMC10859789 DOI: 10.4269/ajtmh.23-0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/29/2023] [Indexed: 01/10/2024] Open
Abstract
Cryptococcus neoformans infections occur most frequently in immunocompromised patients. Here, we report a case of cryptococcal meningitis in a previously immunocompetent 78-year-old female patient after treatment of COVID-19. Underlying diseases included hypertension, hyperlipidemia, and diabetes. The patient was critically ill and was treated with remdesivir, baricitinib, and dexamethasone. During hospitalization, her mental state changed, and C. neoformans was detected in the cerebrospinal fluid. She died despite receiving antifungal treatment. Treatment of COVID-19 may be a predisposing factor for C. neoformans infection. There is a need for concern and countermeasures for opportunistic fungal infections that may accompany COVID-19.
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Affiliation(s)
- Hyunkyu Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea
| | - Subin Kim
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
| | - Mi Young Ahn
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
| | - Dong Hyun Oh
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
| | - Jae-Phil Choi
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
| | - Eunmi Yang
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
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Quincho-Lopez A, Poma N, José Montenegro-Idrogo J. COVID-19 associated with cryptococcosis: a scoping review. Ther Adv Infect Dis 2024; 11:20499361241232851. [PMID: 38361915 PMCID: PMC10868154 DOI: 10.1177/20499361241232851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
Background There is growing evidence of fungal infections associated with COVID-19. The development of cryptococcosis in these patients has been infrequently reported. However, it can be life-threatening. Objective To identify cases of COVID-19 patients who developed cryptococcosis and to compare baseline characteristics and management between those who survived and those who died. Methods We conducted a scoping review using PubMed, Scopus, Web of Science, and Embase to identify studies that reported patients with COVID-19 and cryptococcosis. No language restriction was applied. Single case reports, case series, and original articles were included. It is important to note that 'n' refers to the total number of individuals with the specified variable. Results A total of 58 studies were included. Among these studies, 51 included individual patient data, detailing information on a total of 65 patients, whereas eight studies reported the proportion of cryptococcosis in COVID-19 patients. One study provided both individual and aggregate case information. From individual patient data, the majority were male (73.9%; n = 48) with a median age of 60 years (range: 53-70). Severe COVID-19 and multiple comorbidities, led by arterial hypertension and diabetes mellitus, were frequently reported, but few had classic immunosuppression factors. On the other hand, HIV status, either negative or positive, was reported in just over half of the patients (61.5%; n = 40). Most were admitted to the intensive care unit (ICU) (58.5%; n = 31), received mechanical ventilation (MV) (50.0%; n = 26), and developed disseminated cryptococcosis (55.4%; n = 36). Secondary infection, mainly bacterial, was reported in 19 patients (29.2%). Mortality was 47.7% (n = 31). Of the studies that reported the proportion of cryptococcosis in COVID-19 cases, the majority were descriptive studies published as conference abstracts. Conclusion Cryptococcosis in COVID-19 patients has been reported more frequently. However, it is still not as common as other fungal infections associated with COVID-19. Few patients have some classic immunosuppression factors. The factors associated with mortality were male sex, age, ICU admission, MV, secondary infections, and lymphopenia.
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Affiliation(s)
- Alvaro Quincho-Lopez
- Unidad de Investigación en Bibliometría, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - Nuvith Poma
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Juan José Montenegro-Idrogo
- Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
- Infectious Diseases and Tropical Medicine Service, Hospital Nacional Dos de Mayo, Lima, Peru
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
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3
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Pulmonary Cryptococcosis Complicating Severe Coronavirus Infectious Disease 2019. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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COVID-19 Associated with Cryptococcosis: A New Challenge during the Pandemic. J Fungi (Basel) 2022; 8:jof8101111. [PMID: 36294675 PMCID: PMC9604822 DOI: 10.3390/jof8101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a great threat to global health. In addition to SARS-CoV-2 itself, clinicians should be alert to the possible occurrence of co-infection or secondary infection among patients with COVID-19. The possible co-pathogens include bacteria, viruses, and fungi, but COVID-19-associated cryptococcosis is rarely reported. This review provided updated and comprehensive information about this rare clinical entity of COVID-19-associated cryptococcosis. Through an updated literature search till 23 August 2022, we identified a total of 18 culture-confirmed case reports with detailed information. Half (n = 9) of them were elderly. Fifteen (83.3%) of them had severe COVID-19 and ever received systemic corticosteroid. Disseminated infection with cryptococcemia was the most common type of cryptococcosis, followed by pulmonary and meningitis. Except one case of C. laurentii, all other cases are by C. neoformans. Liposomal amphotericin B and fluconazole were the most commonly used antifungal agents. The overall mortality was 61.1% (11/18) and four of them did not receive antifungal agents before death. Improving the poor outcome requires a physician's high suspicion, early diagnosis, and prompt treatment.
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Regalla D, VanNatta M, Alam M, Malek AE. COVID-19-associated Cryptococcus infection (CACI): a review of literature and clinical pearls. Infection 2022; 50:1007-1012. [PMID: 35322336 PMCID: PMC8942802 DOI: 10.1007/s15010-022-01805-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/09/2022] [Indexed: 02/08/2023]
Abstract
Background Cryptococcal infection has been increasingly reported in patients with COVID-19 infection, but the epidemiological factors, presentation, diagnostic certainty, and outcome have not been well-described. Methods We reviewed the published cases of COVID-19-associated Cryptococcus infections (CACI) to shed the light on the burden of this infection. Results We identified 13 patients with confirmed cryptococcal infection. Cryptococcus infection was primarily seen in patients with severe COVID-19 disease who received corticosteroids therapy and admitted to the intensive care unit. Pulmonary CACI was the most common reported infection followed by cryptococcal meningitis. Conclusion In light of the high mortality rate, clinicians should maintain a high clinical suspicion of CACI in critically ill patients.
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Affiliation(s)
- Dinesh Regalla
- Division of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Mollie VanNatta
- Department of Pharmacy, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Mohammad Alam
- Division of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Alexandre E Malek
- Division of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
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Traver EC, Malavé Sánchez M. Pulmonary aspergillosis and cryptococcosis as a complication of COVID-19. Med Mycol Case Rep 2022; 35:22-25. [PMID: 35018279 PMCID: PMC8734106 DOI: 10.1016/j.mmcr.2022.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 12/19/2022] Open
Abstract
Invasive fungal infections may complicate infection by SARS-CoV-2 and increase morbidity and mortality. A 59-year-old man with multiple medical comorbidities was transferred to our hospital for worsening hypoxic respiratory failure due to COVID-19 and received high-dose corticosteroids and 2 doses of cyclophosphamide. He was diagnosed with pulmonary aspergillosis and cryptococcosis by culture of a bronchoalveolar lavage sample. This patient's secondary infections were likely due to treatment with immunosuppressants, his comorbidities, and his prolonged critical illness.
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Affiliation(s)
- Edward C. Traver
- University of Maryland Medical Center, Division of Infectious Diseases, Baltimore, 21201, USA
| | - Melanie Malavé Sánchez
- University of Maryland School of Medicine, Division of Infectious Disease, Baltimore, 21201, USA
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8
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Pipitone G, Spicola D, Abbott M, Sanfilippo A, Onorato F, Di Lorenzo F, Ficalora A, Buscemi C, Alongi I, Imburgia C, Ciusa G, Agrenzano S, Gizzi A, Guida Marascia F, Granata G, CimÒ F, Verde MS, Di Bernardo F, Scafidi A, Mazzarese V, Sagnelli C, Petrosillo N, Cascio A, Iaria C. Invasive cryptococcal disease in COVID-19: systematic review of the literature and analysis. LE INFEZIONI IN MEDICINA 2022; 31:6-12. [PMID: 36908394 PMCID: PMC9994830 DOI: 10.53854/liim-3101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/25/2023] [Indexed: 03/07/2023]
Abstract
During the Coronavirus Disease 2019 (COVID-19) pandemic, an increasing number of fungal infections associated with SARS-CoV-2 infection have been reported. Among them, cryptococcosis could be a life-threatening disease. We performed a Systematic Review (PRISMA Statement) of cryptococcosis and COVID-19 co-infection, case report/series were included: a total of 34 cases were found, then we added our case report. We collected patients' data and performed a statistical analysis comparing two groups of patients sorted by outcome: "dead" and "alive". Three cases were excluded for lack of information. To compare categorical data, we used a Fisher-exact test (α=0.05). To compare quantitative variables a U Mann-Whitney test was used (α=0.05), with a 95% Confidence Interval. A total of 32 co-infected patients were included in the statistical analysis. Mortality rate was 17/32 (53.1%): these patients were included in "dead" group, and 15/32 (46.9%) patients survived and were included in "alive" group. Overall, males were 25/32 (78.1%), the median age was 60 years (IQR 53-70) with non-statistically significant difference between groups (p=0.149 and p=0.911, respectively). Three variables were associated with mortality: ARDS, ICU admission and inadequate treatment. Overall, 21 out of 24 (87.5%) patients were in ARDS with a statistically significant difference among two groups (p=0.028). ICU admission for COVID-19 was observed in 18/26 (69.2%), more frequently among dead group (p=0.034). Finally, 15/32 (46.9%) patients had adequate treatment (amphotericin B + flucytosine for invasive cryptococcosis) mostly among alive patients (p=0.039). In conclusion, mortality due to cryptococcal infection among COVID-19 patients remains high but an early diagnosis and appropriate treatment could reduce mortality.
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Affiliation(s)
- Giuseppe Pipitone
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Daria Spicola
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Michelle Abbott
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy.,Infectious Diseases Unit, University Hospital Policlinic "Paolo Giaccone", Palermo, Italy
| | - Adriana Sanfilippo
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Francesco Onorato
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Francesco Di Lorenzo
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Antonio Ficalora
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Calogero Buscemi
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Ilenia Alongi
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Claudia Imburgia
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Giacomo Ciusa
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Stefano Agrenzano
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Andrea Gizzi
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy.,Infectious Diseases Unit, University Hospital Policlinic "Paolo Giaccone", Palermo, Italy
| | - Federica Guida Marascia
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy.,Infectious Diseases Unit, University Hospital Policlinic "Paolo Giaccone", Palermo, Italy
| | - Guido Granata
- Clinical and Research Department for Infectious Disease, INMI "L. Spallanzani", Rome, Italy
| | - Francesco CimÒ
- Pharmacology Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Maria Stella Verde
- Microbiology Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | | | - Antonino Scafidi
- Intensive Care Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Vincenzo Mazzarese
- Intensive Care Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Caterina Sagnelli
- Infectious Diseases Unit, University "Luigi Vanvitelli", Naples, Italy
| | - Nicola Petrosillo
- Infection Prevention & Control and Infectious Diseases Unit, University Hospital "Campus Bio-Medico", Rome, Italy
| | - Antonio Cascio
- Infectious Diseases Unit, University Hospital Policlinic "Paolo Giaccone", Palermo, Italy
| | - Chiara Iaria
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
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Chastain DB, Henao-Martínez AF, Dykes AC, Steele GM, Stoudenmire LL, Thomas GM, Kung V, Franco-Paredes C. Missed opportunities to identify cryptococcosis in COVID-19 patients: a case report and literature review. Ther Adv Infect Dis 2022; 9:20499361211066363. [PMID: 35070297 PMCID: PMC8771738 DOI: 10.1177/20499361211066363] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 may activate both innate and adaptive immune responses ultimately leading to a dysregulated immune response prompting the use of immunomodulatory therapy. Although viral pneumonia increases the risk of invasive fungal infections, it remains unclear whether SARS-CoV-2 infection, immunomodulatory therapy, or a combination of both are responsible for the increased recognition of opportunistic infections in COVID-19 patients. Cases of cryptococcosis have previously been reported following treatment with corticosteroids, interleukin (IL)-6 inhibitors, and Janus kinase (JAK) inhibitors, for patients with autoimmune diseases, but their effect on the immunologic response in patients with COVID-19 remains unknown. Herein, we present the case of a patient with COVID-19 who received high-dose corticosteroids and was later found to have cryptococcosis despite no traditional risk factors. As our case and previous cases of cryptococcosis in patients with COVID-19 demonstrate, clinicians must be suspicious of cryptococcosis in COVID-19 patients who clinically deteriorate following treatment with immunomodulatory therapies.
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Affiliation(s)
- Daniel B. Chastain
- Department of Clinical & Administrative Pharmacy, College of Pharmacy, University of Georgia, 1000 Jefferson Street, Albany, GA 31701, USA
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Austin C. Dykes
- Department of Clinical & Administrative Pharmacy, College of Pharmacy, University of Georgia, Albany, GA, USA
| | - Gregory M. Steele
- Infectious Diseases, Phoebe Putney Memorial Hospital, Albany, GA, USA
| | | | - Geren M. Thomas
- Department of Pharmacy, John D. Archbold Memorial Hospital, Thomasville, GA, USA
| | - Vanessa Kung
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Carlos Franco-Paredes
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USAHospital Infantil de México, Federico Gómez, México City, México
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Gil Y, Gil YD, Markou T. The Emergence of Cryptococcemia in COVID-19 Infection: A Case Report. Cureus 2021; 13:e19761. [PMID: 34938636 PMCID: PMC8685839 DOI: 10.7759/cureus.19761] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 12/15/2022] Open
Abstract
Cryptococcus neoformans is a fungus that can cause pulmonary, central nervous system, and dermatological infections, especially in an immunocompromised patient. This is a case report of a patient, who was presumptively immunocompetent that developed isolated cryptococcemia while being treated for coronavirus disease 19 (COVID-19) infection. We report a case of a 59-year-old Hispanic man with a past medical history of hypertension, well-controlled diabetes mellitus, and class I obesity who was admitted for severe acute respiratory distress syndrome coronavirus 2 (SARS-COV-2) and subsequently was diagnosed with cryptococcal fungemia. The patient received 21 days of dexamethasone and during this period, blood and fungal cultures grew C. neoformans. The patient was alert and oriented, did not have focal neurological deficits or meningeal irritation signs; nonetheless, a lumbar puncture was attempted, but not successful. He was treated with intravenous amphotericin B for two weeks, followed by oral fluconazole for six weeks. Repeat blood cultures demonstrated clearance and he improved clinically. In conclusion, this case report describes the possibility of an association between the use of dexamethasone in COVID-19 patients and the development of cryptococcal fungemia. In the review of literature, rare case reports worldwide have discussed this topic. This is clinically challenging as the emergence of opportunistic infections in these debilitated hosts can be detrimental. Maintaining a high clinical suspicion for this opportunistic infection while treating COVID-19 patients is necessary to prevent further mortality associated with this pandemic.
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Affiliation(s)
- Yerandy Gil
- Internal Medicine, Saint Clare's Health, Denville, USA
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